Acute kidney injury in COVID-19: are kidneys the target or just collateral damage? A comprehensive assessment of viral RNA and AKI rate in patients with COVID-19

Enikeev, Dmitry; Taratkin, Mark; Efetov, Sergey; Shlomina, Alexandra; Boldyreva, Margarita; Galkina, Irina; Spivak, Leonid; Gitel, Evgeniy; Kuchieva, Agunda; Mikhailov, Vasiliy; Teoh, Jeremy Yuen-Chun; Herrmann, Thomas R.W.; Kikic, Željko; Fomin, Viktor; Shariat, Shahrokh F.; Glybochko, Petr

PURPOSE OF REVIEW: To investigate the possible effects of severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) on kidney function and assess the rate of viral ribonucleic acid (RNA) shedding/detection in urine. RECENT FINDINGS: Most of the research on the topic suggests that for the moment our ability to estimate whether SARS-CoV-2 is a direct causative agent in acute kidney injury (AKI) or whether it has a cytokine storm effect is limited. During our prospective assessment of 333 patients with COronaVIrus Disease 2019 (COVID-19) it was found that frequency of AKI of 9.6% (32 cases). Despite previous data suggestive of the ability to detect SARS-CoV-2 in urine, we were unable to identify any traces of messenger ribonucleic acid (mRNA) in our group. Both COVID-19 severity (odds ratio, OR = 23.09, confidence interval, CI 7.89–67.57, P < 0.001) and chronic kidney disease (CKD) history (OR = 7.17, CI 2.09–24.47, P = 0.002) were associated with the AKI rate. SUMMARY: AKI is a relatively frequent condition for patients with COVID-19 and is normally correlated with the severity of the disease and the patient's history of CKD. The available data fail to address whether SARS-CoV-2 mRNA is present in urine, whereas our prospective trial data suggest that mRNA is undetectable in urine irrespective of the severity of the disease.